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Texas’ Medicaid Expansion Refusal Hits Working Single Moms and Latinos Worst

Photo: via Progress Texas, License: N/A

via Progress Texas


Irma Aguilar, a 28-year-old San Antonio native and single mother of four, struggles to make ends meet. As an assistant manager at Pizza Hut burdened with health problems, Aguilar finds herself caught in an almost unbelievable circumstance; she makes too much to be enrolled in Medicaid and too little to afford the program under the Affordable Care Act’s marketplace.

“I have no idea what I’m going to do … if I’m forced to pay hundreds of dollars a month for health care, I’ll be completely broke,” she tells the Current. “It’s very stressful and it’s just not fair to those of us paying taxes and working hard.”

Unable to afford treatment, Aguilar suffers from ailments including anxiety, high blood pressure and an injured back. She says securing a second job is out of the question due to the expense she’d have to incur for childcare.

Aguilar is not alone. She and an estimated one million poor Texans fall into the “coverage gap”—those left out of the potential benefits that come along with expanded Medicaid coverage under the Affordable Care Act, legislation designed to grant all legal U.S. residents healthcare. While 26 states accepted the expansion (including ones with similarly conservative guvs like Arizona’s Jan Brewer), Gov. Rick Perry, in a move criticized as a largely political gesture, refused the billions in public assistance. Today, Texans account for more than 22 percent of U.S. residents whose leadership denied them the federal assistance.

Who else got left behind? With the exception of being pregnant, disabled or extremely poor and taking care of children, adults under 65 with incomes below the poverty line, meaning below $958 per month for one or $1,963 per month for a family of four, could be left out. That includes thousands of veterans as well as retail, construction and food service employees in San Antonio. Perry’s decision left 179,654 Bexar County residents from obtaining Medicaid coverage, totaling $503.5 million forgone dollars, according to figures compiled by the non-partisan Kaiser Family Foundation. And, in Texas, the denial of federal funds hits Latinos the hardest—with 60 percent of the population uninsured as it is, some 583,000 Texas Latinos fall into the gap, according to Kaiser, far surpassing any other racial or ethnic group.

The failure to expand has allowed for some ongoing counterintuitive circumstances for Texans.

Anne Dunkelberg, associate director at the Center for Public Policy Priorities (CPPP) points to the example of a single mother of two making $18,500 and a single male with no dependents earning the same amount. In this case, the man is considered above poverty (defined as $11,670 for one person) and can sign up for the ACA marketplace but the mother, considered below poverty (family of three: $19,790), won’t qualify for either Medicaid or subsidies.

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